{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T12:01:24Z","timestamp":1772107284982,"version":"3.50.1"},"reference-count":24,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,2,25]],"date-time":"2026-02-25T00:00:00Z","timestamp":1771977600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Pediatric neurosurgical procedures often involve significant blood loss and rapid hemodynamic shifts, necessitating accurate hemoglobin (Hb) monitoring. While continuous non-invasive Hb (SpHb) monitoring offers real-time trending, its accuracy in high-risk pediatric populations remains debated. We aimed to evaluate the diagnostic accuracy and clinical utility of SpHb compared to invasive arterial blood gas (ABG) analysis in pediatric patients undergoing cranial and spinal surgeries. Methods: This prospective, observational study enrolled 60 pediatric patients (aged 0\u201316 years) scheduled for high-risk neurosurgery. SpHb was measured continuously and compared with intermittent ABG-Hb values. Statistical analysis included Bland\u2013Altman agreement, Pearson\u2019s correlation, and Error Grid Analysis. Subgroup analyses assessed the impact of the Perfusion Index (PI), hypotension, and metabolic acidosis on device performance. Results: Data from 57 patients (median age: 12 months, interquartile range: 6\u201342 months; 70.2% aged &lt;24 months) were analyzed. SpHb demonstrated a moderate correlation with ABG-Hb (r = 0.567, p &lt; 0.001) but exhibited systematic overestimation with a mean bias of +1.60 \u00b1 1.54 g\/dL. Crucially, SpHb showed 0% sensitivity for detecting critical anemia (Hb &lt; 8.0 g\/dL). Device performance was significantly compromised by physiological extremes: severe metabolic acidosis significantly increased bias to +2.27 g\/dL (p = 0.038), and intraoperative hypotension significantly widened the limits of agreement (SD of bias: 1.79 g\/dL vs. 1.45 g\/dL in normotension). Furthermore, hemodynamic analysis revealed a loss of autoregulation during hypotension, where the pressure-perfusion coupling strengthened (r = 0.44) compared to the normotensive state (r = 0.15). Conclusions: SpHb monitoring provides fair Hb trending but is limited by systematic overestimation and poor sensitivity for critical anemia. Accuracy worsens during severe acidosis and hemodynamic instability. Therefore, SpHb should function as a complementary \u201cearly warning\u201d trend monitor rather than a sole transfusion trigger, with invasive validation remaining essential for intraoperative decision-making.<\/jats:p>","DOI":"10.3390\/children13030323","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T10:33:02Z","timestamp":1772101982000},"page":"323","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Is Pulse Co-Oximetry a Reliable Alternative to Invasive Hemoglobin Measurement in Pediatric Neurosurgical Procedures?"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7345-0318","authenticated-orcid":false,"given":"Funda","family":"Arun","sequence":"first","affiliation":[{"name":"Department of Pedodontics, Division of General Anesthesia, Faculty of Dentistry, Selcuk University, Selcuklu, Konya 42130, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6101-1481","authenticated-orcid":false,"given":"Oguzhan","family":"Arun","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Faculty of Medicine, Selcuk University, Alaaddin Keykubat Campus, Akademi Mahallesi Yeni Istanbul Caddesi No:313, Selcuklu, Konya 42130, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"127","DOI":"10.4103\/0259-1162.94749","article-title":"Pediatric neurosurgery, special attention is required!","volume":"5","author":"Alsatli","year":"2011","journal-title":"Anesth. Essays Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1152\/japplphysiol.00994.2015","article-title":"Predictors of cerebral blood flow in patients with and without anemia","volume":"120","author":"Borzage","year":"2016","journal-title":"J. Appl. Physiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"137","DOI":"10.13004\/kjnt.2024.20.e26","article-title":"Optimizing RBC Transfusion Strategies in Traumatic Brain Injury: Insights on Early Resuscitation and Cerebral Oxygenation","volume":"20","author":"Ha","year":"2024","journal-title":"Korean J. Neurotrauma"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1016\/j.bja.2024.08.034","article-title":"Perioperative paediatric patient blood management: A narrative review","volume":"134","author":"Goobie","year":"2025","journal-title":"Br. J. Anaesth."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e000614","DOI":"10.1136\/wjps-2023-000614","article-title":"Continuous non-invasive hemoglobin monitoring in pediatric trauma setting","volume":"6","author":"Romanelli","year":"2023","journal-title":"World J. Pediatr. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"701529","DOI":"10.1155\/2013\/701529","article-title":"How Noninvasive Haemoglobin Measurement with Pulse CO-Oximetry Can Change Your Practice: An Expert Review","volume":"2013","author":"Lindner","year":"2013","journal-title":"Emerg. Med. Int."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"2055","DOI":"10.1016\/j.jpedsurg.2017.12.015","article-title":"Continuous hemoglobin monitoring in pediatric trauma patients with solid organ injury","volume":"53","author":"Welker","year":"2018","journal-title":"J. Pediatr. 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